Provider Demographics
NPI:1972563427
Name:GARY, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:GARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37864
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-7864
Mailing Address - Country:US
Mailing Address - Phone:610-382-5916
Mailing Address - Fax:484-381-8028
Practice Address - Street 1:200 STATE STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-521-4112
Practice Address - Fax:610-521-6864
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PAMD036095E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC33362Medicare UPIN
C33362Medicare UPIN
PA198948Medicare PIN
PA198948XDKMedicare PIN